Randomized clinical trial of a brief, scalable intervention for mental health sequelae in college students during the COVID-19 pandemic

Shireen L Rizvi, Jesse Finkelstein, Annmarie Wacha-Montes, April L Yeager, Allison K Ruork, Qingqing Yin, John Kellerman, Joanne S Kim, Molly Stern, Linda A Oshin, Evan M Kleiman, Shireen L Rizvi, Jesse Finkelstein, Annmarie Wacha-Montes, April L Yeager, Allison K Ruork, Qingqing Yin, John Kellerman, Joanne S Kim, Molly Stern, Linda A Oshin, Evan M Kleiman

Abstract

This randomized clinical trial aimed to determine feasibility, acceptability, and initial efficacy of brief Dialectical Behavior Therapy (DBT) skills videos in reducing psychological distress among college students during the COVID-19 pandemic. Over six weeks, 153 undergraduates at a large, public American university completed pre-assessment, intervention, and post-assessment periods. During the intervention, participants were randomized to receive animated DBT skills videos for 14 successive days (n = 99) or continue assessment (n = 54). All participants received 4x daily ecological momentary assessments on affect, self-efficacy of managing emotions, and unbearableness of emotions. The study was feasible and the intervention was acceptable, as demonstrated by moderate to high compliance rates and video ratings. There were significant pre-post video reductions in negative affect and increases in positive affect. There was a significant time × condition interaction on unbearableness of emotions; control participants rated their emotions as more unbearable in the last four vs. first two weeks, whereas the intervention participants did not rate their emotions as any more unbearable. Main effects of condition on negative affect and self-efficacy were not significant. DBT skills videos may help college students avoid worsening mental health. This brief, highly scalable intervention could extend the reach of mental health treatment.

Keywords: Brief interventions; COVID-19; College students; Dialectical behavior therapy; Dissemination.

Conflict of interest statement

Dr. Rizvi provides consultation and training for Behavioral Tech, LLC. Drs. Rizvi and Kleiman receive external grant funding from the National Institute of Mental Health.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Representative screenshots from brief DBT skills videos.
Fig. 2
Fig. 2
Participant flow.
Fig. 3
Fig. 3
EMA compliance rate throughout the study, by group.
Fig. 4
Fig. 4
Within-person comparisons of pre-post-video affect ratings.
Fig. 5
Fig. 5
Condition × period interaction on unbearability of emotions.

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